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grr ELECTRICAL PERMIT APPLICATIORIGINAL
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> t .
<br /> PROJECT ADDRESSs 2/u At 2 6 ..< .
<br /> BUILDING AREA(if residential,new construction,remodel,or a 4 SF
<br /> BUILDING TYPE: 0 SFR-DETACHEDXSFR-ATTACHED pUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> USE OF BUILDING:
<br /> gi PaVe, , - - H "::. E ttl.: ., . .. O 11NF R
<br /> x1T740s larMi
<br /> aJAa '
<br /> CONTRACT PRICE OF WORK:$ U" C)
<br /> 0
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT it,a plicable): ^hr
<br /> DESCRIPTION OF WORK: ( �1 j � ( l/l V, l i/\c O,S C 1-
<br /> ev 181Iiq yiV �I�r a� ii'n iiV Ilii D s�iPtiri=�� ,•�. YI ,_..-. �_s. _,�,.. ��u.. "..�,wa hiaN a ��yamiai �� ;; � i,n i i�,�i i ti�.� � q��P IIS{. ilii
<br /> �fli�I a,,, kp 161��,Ili�� 4 fi>� @a _ ;. ,amu• � _ail i o. �' ria.4�iili.!i 1, � lull.;� r il.I�tN�gPlli a
<br /> ih'4111p;iii r , ";I�V i4 ;i II;�I (9t f e�; �! i-4lliili'Illl��HIpp,.,t '' �'li'(Ii Ii��II N111 4,,„,4„,,,,,di j (� ..�,I, ,(II� k,,�`.;'
<br /> a��z - ,, ,� I _ ;�a` C_ T y011Z I� �I�I;;,6 � �,;.i III il" ,.I i IV
<br /> �'�O�iili,,� r.� � I ,,.�n � ,��,� _.. ��5�—�r�NL � 3Y� � F� �� �a�la� �� �6u 'o ii�i��en��ll��l��>u>hhi.���t��d �E4�ryP? iwu_`:
<br /> OWNER NAME: (S_-(,,p f TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS:ISTREET ( UX I "i ;
<br /> CITY .."\,7"-eit("Ce--"-tt STATE LA ZIP c9 _
<br /> OWNER PHONE: t- f'l/ '„3\01-- 3(.Q 2)?) OWNER EMAIL: V\ I CA
<br /> CONTRACTOR NAME: g I.I }.Q 'FICA-V1A—R/
<br /> CONTRACTOR ADDRESS: STREET1 l \ LQ - ” lJ v VJ+44 I -{(��
<br /> CITY I v ` 1 /
<br /> V ASTATE A ZIP c1 � \ 3
<br /> CONTRACTOR PHONE: f `1' \' --1_,41 CONTRACTOR�, EMAIL: f'/'-
<br /> CONTRACTOR UC.#(REQUIRED): L k-FIs `//QCITY OF EVERETT BUSINESS LIC.#(REQUIREDQ.S)--1 1
<br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: ,�, �_ CONTACT PHONE: L. '2c, 1-1 1. 1 ( 9
<br /> KOi (o-v\-&- !r�AA-DA"Di n` L . CONTACT EMAIL: A; A,
<br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
<br /> type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or
<br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAG
<br /> City of Everett Official Use Only
<br /> FEE
<br /> �j PERMIT# !r
<br /> • ' III—.I., `.`I•iiii, b C 1 v'- I 1 O E / SO�0— (q3
<br /> Owner/Auth. ' - Agent SI. Date (Revised 10/12/2015)
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